Infant Nutrition, Best Practice and the Mom/Baby Dyad: Statement on “Fed Is Best”

Recently, the Fed is Best (FIB) Foundation blog blasted social media with a story about an infant named Landon who died at 19 days of age from hypernatremia dehydration. All of us who work in medical and allied medical professions are saddened when such events occur. We question our practice; not wanting it to happen again. The International Childbirth Education Association (ICEA) Board of Directors sends our heartfelt sympathy to Landon’s family.

ICEA stands behind “Freedom to Make Decisions” with all issues and practices encompassing the perinatal period. With that, we need to be diligent in understanding the whole issue. The FIB Foundation is promoting their agenda that exclusive breastfeeding is dangerous. This information is not based on evidence and best practice but rather on rare but scary events.

Exclusive breastfeeding is safe and is the method of infant nutrition endorsed by national authorities including: Centers for Disease Control (CDC), the American Academy of Pediatrics (AAP), the American Academy of Breastfeeding Medicine (ABM), American Academy of Family Physicians (AAFP) and the Association of Women’s Health, Obstetrics and Neonatal Nurses (AWHONN). Additionally, the same practice is endorsed from international authorities such as the World Health Association (WHO), the Canadian Pediatric Society (CPS), and the United Nations International Children’s Fund (UNICEF).

As educators, doulas, lactation professionals, and other allied professionals working with families, we need to remember that there are rare cases that can lead to bad outcomes without further assessment and close follow up care. The Baby Friendly Hospital Initiative (BFHI) is the designating body assisting hospitals with meeting the 10-Steps to Successful Breastfeeding. Hospitals working under this designation should be using the Guidelines and Evaluation Criteria which state that “additional individualized assistance should be provided to high risk and special needs mothers and infants, and to mothers who have breastfeeding problems”. For many reasons, one being that it was over five years ago, we do not know the specifics behind Landon’s death. Many professionals have questions that cannot be answered. However, it has come to light in news reports that there were possibly some critical factors that put Landon at high risk.

FIB Foundation is promoting that babies should be given formula supplementation as a standard in hospital settings to avoid this type of tragic situation. It is imperative that we remember that rare events should not dictate standard practice. Formula is not risk freeand does change the infant’s gut. Changes to the gut can have long term health consequences. Additionally, it can negatively impact the establishment of mother’s milk supply and effect the ability for long term breastfeeding success.

Occasionally, the decision is made to use formula and that falls within the Guidelines and Evaluation Criteria of BFHI. This should be an educated decision between mom and care providers after close assessment, monitoring, and attempts to ensure adequate milk transfer. Hand expression and alternate feeding method are the first choice for supplementation, banked human milk (if available) is the next best alternative. Artificial milk (formula) should be the last choice when supplementation is necessary.

Fed is Best is operating on scare tactics that undermine a woman’s confidence in her body and her baby. Additionally, they are creating a false idea that exclusive breastfeeding practices are rigid and don’t allow for feeding choice or alternate care plans when necessary. Withholding food has never been the agenda of BFHI or other practices that promote exclusivity. Professionals and parents need to have open dialogue about their feeding decisions. Childbirth educators, doulas, and lactation professionals are in the unique role to help guide parents with education and decision making to make the best choice for their baby on an individual basis.

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The International Childbirth Education Association (ICEA) is a professional organization that supports educators and health care professionals who believe in freedom to make decisions based on knowledge of alternatives in family-centered maternity and newborn care.